FAQs for Mid-Urethral Slings

I often have patients ask me about Mid-Urethral Slings to treat and prevent their stress urinary incontinence. The first thing I tell patients is that the FDA has deemed Mid-Urethral Slings as safe, and I’ve personally seen this option work for many women who struggle with the loss of urine during physical activities. Here is a list of a few FAQs to review, originally published by AUGS. To see the full list, click here. Call my office to learn more about how this procedure can change your life.

What is a mid-urethral sling (MUS)?
A mid-urethral sling (MUS) is a small mesh strip used in surgery to treat stress urinary incontinence, a type of leakage that occurs during activity such as laughing, coughing, or exercise. The mid-urethral sling works to prevent or significantly reduce the loss of urine during these activities.

The surgery is done through a small incision in the vaginal wall below the urethra (the tube through which urine passes from the bladder). Through this incision a half-inch wide strip of polypropylene mesh is placed between the urethra and the vagina. The ends of the mesh are passed out incisions in the groin or above the pubic bone. Using absorbable suture, the vaginal incision is closed covering the sling.

Are mid-urethral slings safe?
The mid-urethral sling is considered safe and effective by the US Food and Drug Administration (FDA). As with any surgery, complications can occur but they are typically minor and can usually be repaired.

What sort of evidence supports the efficacy and safety of the mid-urethral sling?
The mid-urethral sling procedure is the most studied surgery to treat stress urinary incontinence and there have been over 2,000 articles published about it. Results of these studies have appeared in prestigious medical journals such as the New England Journal of Medicine. Two large government funded studies have evaluated the mid-urethral sling’s safety and efficacy – both found the procedure to have a low complication rate and a high success rate. Other large scientific studies from around the world have supported the safety and efficacy of the mid-urethral sling.

What is the difference between a mid-urethral sling and vaginal prolapse mesh?
A mid-urethral sling is used to treat stress urinary incontinence. A vaginal prolapse mesh is placed through a vaginal incision to correct a vaginal bulge (ex. cystocele, rectocele or dropped uterus). Vaginal prolapse mesh is larger and placed in a different location than the mid-urethral sling mesh.

Does a mid-urethral sling cause cancer?
There is no evidence that any women have developed cancer as a result of a mid-urethral sling.

Does a mid-urethral sling cause any other diseases?
There is no evidence that polypropylene mesh or mid-urethral sling causes other diseases.

A Q&A about the MonaLisa Touch

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When I first learned about the MonaLisa Touch laser, I wondered if it was too good to be true. Could a vaginal laser really help post-menopausal women and breast cancer patients experience healthy regrowth of their thinning vaginal walls? I had to see it to believe it. I traveled to California in November 2015 to watch other doctors perform the treatment. To my amazement, many women reported back with noticeable changes after only one session.

I had to bring the MonaLisa Touch to Houston Female Urology – and the response has been amazing. Not only are the treatment sessions approximately five minutes, my patients say that the laser is virtually painless and they can continue on with their day as soon as they leave the office.

I want to share some honest answers with you. I asked one of my patients, Sharon S., to answer a few questions and share her real experience with the MonaLisa Touch. See what she said:

What was life like before your first MonaLisa Touch treatment?
I had age-related symptoms of dryness, burning and pressure resulting in frequent trips to the bathroom. I also experienced drips when sneezing and coughing. I thought I was going to have to learn to live with these problems; however, after my first MonaLisa Touch treatment, I saw improvements in all areas, and I couldn’t wait for my second and third treatments.

Tell me about the day you had the treatment…
On the day of my first treatment, I left the office and continued with what I had scheduled without a problem. The procedure was no worse than having a pap smear. Within the first week of my first treatment I saw a difference in each of the symptoms I was experiencing. I was actually pleasantly surprised that I had improvements so soon.

How did your MonaLisa Touch treatment impact your life?
I have had all three of my treatments, and I can say there has been an even bigger difference with the symptoms I was experiencing. I stopped using my estrogen cream because the problem with dryness was gone, the burning is not a problem, and the pressure when needing to urinate is gone. I am making less trips to the bathroom at night (unless I drink an unusual amount of water before bed), and experiencing no drips. Not only have I experienced a difference, but my husband said that he could tell a difference during intimacy. I also have been able to tell a difference. It is worth it, and I would do the procedure again without question.  

This really works. My patients and other women throughout the world are seeing results. Are you ready to learn more? Join me for a free seminar at my office about the treatment. Give us a call! (281) 717-4003

-Dr. P

Meet My Amazing Staff – Serving you in 2016


I want to introduce my team in this blog. I can’t believe how incredibly blessed I am to have been able to find such wonderful people to work for/with me and help me take care of my patients. I am nothing without my staff. These women bring so much life, excitement and knowledge to my team, and each individual is vital to the success of Houston Female Urology.

Each team member has been hand-selected by me, so that I can ensure that they encompass my vision for providing exceptional medical care to every patient on every visit. Patients always comment that they can really see a difference in my office, and I attribute it to a staff that goes above and beyond the call.

Houston Female Urology truly is a staff of excellence. My team rolls out the red carpet for each and every patient. Here, patients are given the attention they deserve on every appointment, and we take time to listen to patients and understand their needs. Every day, we strive to be knowledgeable, gentle and kind. Throughout 2016, it is our promise to continue to excel in quality medical care.

Now, I want to introduce you to each member of my team so you can get to know us a little better and feel right at home on your next visit!

Kim Brey, Physician Assistant, is an astute clinician who takes time to listen to patients intently and is excellent at trouble-shooting. Sometimes I think we share a brain since we think so much alike! Kim studied psychology prior to medicine and is the proud mother of an energetic, handsome boy. She has worked with me for the last three years and has 10 years of urology experience. Learn more about Kim, here.

Carrie Hiatt, Medical Assistant, is intuitive, very intelligent and gentle on procedures. She is full of ideas. She does an excellent job with Urodynamics, Pelvic Floor Muscle Training and surgery scheduling. We started working together four years ago. Carrie is a proud “cat-mother” of two felines and loves to cook vegetarian meals and baked goods.

Marissa Mattyre, LVN, is on the phone most of the day but also does several procedures. She is a very patient nurse and quick to respond to patient phone calls and needs. She is able to determine what the patient needs and efficiently help them. Marissa is married and has three beautiful girls. She was a massage therapist prior to attending nursing school. She is the newest member of our team and has been with me for six months.

Patty Ramos, Medical Assistant, is my sidekick day-to-day in the office.  She is a dynamo and is full of energy and initiative. She warmly greets each patient and helps get them set up for me to come in to see them. She clearly explains the next steps and also does a great job with Pelvic Floor Muscle Training. Patty is married with two beautiful daughters and has worked with me on-and-off for 13 years.

Mary Yanez, Medical Assistant, helps Kim with her clinic and occasionally helps me as well. She is soft-spoken and gentle. Mary is wonderful at the initial patient intake and teaching patients what they need to know. She is married with a beautiful teenage girl and a handsome toddler boy.  We have worked together periodically over the last six years.

Yoisel Betancourt, Front Desk Specialist, warmly greets patients on the phone and at the reception window. She’s a great first impression for my office. She is very organized and very knowledgeable about insurance. Yoisel also comes up with great decorative signs to celebrate office events. She has a beautiful young daughter and is a make-up artist on the weekends.

Ria Avelar, Front Desk Specialist, is very helpful with phone calls about insurance. She takes a lot of time to help out the patients with questions. Ria is also well-versed in the various plans. She also is very warm with patients and makes them feel comfortable. Ria is married and has two beautiful baby sons 18 months apart!

Marlene Magness, Practice Administrator, has been wonderful for my practice. Having worked in hospitals in the past, she was not unfamiliar with medicine, but managing a private practice required learning a lot of new things. She has tackled numerous challenges with gusto and has been such a great leader for my team. She runs things with a steady hand and helps me and the patients in countless ways. Marlene’s true love, however, is antiquing and you can find her at Round Top during the festival season.

As you can see, I am one lucky and blessed girl to have such a great team. I hope that knowing about my staff will help you feel even more comfortable when you come visit us.

To schedule your appointment with my team, visit us online to review next steps!

Looking Back at 2015

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As 2015 draws to a close, I can’t help but look back on this year and think about how far Houston Female Urology has come since we first opened in July 2014. This year we celebrated our one-year anniversary. That’s one year in the books as the only urology practice in Texas that exclusively serves women. This is something that makes my team so proud. It’s an honor to help our patients get their lives back and say goodbye to urological issues every day.

This year we also added the MonaLisa Touch laser – a leading edge treatment that resolves gynecologic health issues often caused by menopause. I offer this as an in-office procedure that is virtually painless and requires no anesthesia. I am excited to be one of the first physicians in Houston to offering this treatment to help postmenopausal women and breast cancer survivors. (We are also thrilled that the Houston Chronicle covered our story!)

I love interacting with my patients. One way I did this in 2015 was through free seminars. My team organized two amazing events where our patients (and their friends!) were able to gather and learn more about urological issues and treatment options. We had drinks, snacks, door prizes – the events were so successful that I’m already planning more free events for 2016!

Giving back is something that is really important to my practice. This year we gave new athletic clothing wear and monetary donations to Houston Area Women’s Center. We prayed that these donations would bless the women who receive them as they break free from domestic abuse and start a new life.

So as the year winds down and Christmas approaches, I pray for real joy and peace for the whole world. So much heartache has happened in 2015, and it reminds me of the poignant lyrics of the Christmas song, Oh Holy Night – “A thrill of hope, the weary world rejoices.” Take time to rest and not get caught up in the hustle and bustle of the season. This is a time for joy – God reached down to touch mankind.

Enjoy your fresh start to a new year, and come see me in 2016! I can’t wait to continue providing the same great care to my patients.

Dr. P

Meet the MonaLisa Touch

 

MonaLisaTouchI am thrilled to announce that I will be introducing a new vaginal laser treatment as an outpatient procedure this fall at Houston Female Urology. As the first urologist in Houston who’s taking advantage of this groundbreaking technology, I can’t wait for my patients to reap the benefits! Meet the MonaLisa Touch.

The MonaLisa touch is a treatment aimed at combating vaginal atrophy. Vaginal atrophy may be caused by hormonal changes during menopause, and it may also occur in women who experience a decreased estrogen production due to cancer or breastfeeding. Thinning, drying and inflammation of the vaginal walls are typical characteristics, and it may cause intercourse to be painful and contribute to problems with urination.

My patients who experience these symptoms will now be able to restore youthful, trophic conditions in the vulvo-vaginal area with the MonaLisa Touch. The MonaLisa Touch is a minimally invasive laser method that is completely reliable. Its CO2 laser source emits an impulse, and the method does not trigger negative effects like some hormone-based therapies.

Often during the period of menopause, the vagina is subject to a loss of swelling and hydration of tissues, which may cause discomfort for many women. As I mentioned earlier, some of the symptoms include itchiness, dryness, burning, loosening of the vagina and pain during sexual intercourse. Not only do these symptoms cause discomfort, but they can also interfere with your quality of life.

I am excited about the MonaLisa Touch because it naturally and painlessly overcomes vaginal atrophy by triggering physiological processes that eliminate signs of aging. Most importantly, the treatment brings an improvement in physical conditions that enable women to feel like their vulvo-vaginal areas are aging in reverse.

Stay tuned as we share more information throughout the coming days and weeks about the MonaLisa Touch. I think you’re going to love it!

Dr. P

Everyone has a story

Doctor and patient

Before I became a PA, I used my Master’s degree in Psychology to work with the severely mentally ill. During this time, I learned that everyone has a story to tell.

While training in PA school at Saint Louis University, one of my instructors told our class that the most crucial part of an appointment is taking an accurate history and knowing what questions to ask. After this, you need to allow the patient to talk, because they will often give you the diagnosis.

Throughout my 10 years as a PA, I have used the skills I acquired in these two learning environments to encourage my patients to tell their story and chronicle the events that led up up their appointment.

During their story, I only interrupt at a minimum to verify my understanding while collecting pertinent details. When the story concludes, I typically only ask a few additional questions to fine tune an accurate history.

If I don’t have a diagnosis by this point, I’ve at least narrowed down to a handful of possibilities before conducting the physical exam and ordering labs, imaging and office procedures.

Make no mistake, I realize that listening is a skill that takes time, patience and practice to hone. As the provider, you must train yourself to quiet your thoughts and remain in the moment with the patient. Remember those seemingly insignificant details, because you often must make inferences and deductions. Lastly, you need to listen to what they are not saying.

This process takes a little longer than other methods. However, the clear benefit is that fewer delays are encountered while developing an accurate diagnosis. The end result is that the provider initiates an effective and appropriate treatment more quickly, which leads to better outcomes for the patient.

– KIM BREY, PA-C

One Year in Practice!

Houston Female Urology team

“Tomorrow morning at 8:00 we will have the ribbon-cutting and then start the actual business of seeing patients, ready or not! At this point, I can only pray that God will bless this practice, as I use the gifts, talents and passion that He has given me to bless the people that walk through our door.  Tomorrow starts the next chapter of my life!”

This excerpt is from my first blog entry. I wrote this the day before I prepared to open the doors and welcome patients into my brand new practice. I was feeling so many emotions! Excitement, stress, peace, fatigue, joy.

I took a big leap of faith, and looking back on the past year in private practice, I see God’s blessings in every area of my personal and professional life.

This month marks a huge milestone for me. I’ve successfully made it through one year in this new chapter of my life. It is important for me to stop and reflect on my influencers and supporters and share my thankfulness to so many people who have made this year possible:

MY STAFF
I’ve built such a wonderful, thoughtful and knowledgeable team of women around me! They have supported me every step of the way and have truly caught the vision for what we are doing here. Patients truly see a difference when they come to the office. I get comments from patients almost daily that they have never been to such a great doctor’s office where everyone is helpful and cares about them.  I’m so proud of each one of them.

MY REFERRING DOCTORS
I am so thankful every day for the valuable relationships I’ve fostered throughout the years with Houston-area doctors. These colleagues have supported my practice and believed in my team to provide quality urological care as they refer their own patients for us to take care of.  We do not take it for granted and strive to provide great service at all times.

MY MENTORS
I have learned so much from other physicians who are further down the path than I am.  They have been so generous to share their wisdom and insight.  There are many pieces that have to fit together when you start a new practice, and my mentors have been great to help me put it all together.

MY PATIENTS
I owe so much to my loyal patients. These women have trusted me and my team to provide solutions for their urological needs, and I am always blessed by their kind words, success stories and commitment to Houston Female Urology.  You are the reason I am here, and I hope to continue to earn your trust and loyalty for many more years to come.

MY FAMILY
Most importantly, my family has stood beside me through thick and thin. They have shared in my successes and encouraged my spirit. None of this would be possible without my amazing husband and two children! They have been great cheerleaders while I have embarked on this endeavor.

This journey is only beginning…I have so much to look forward to throughout the coming years! I can’t wait to continue to develop and grow Houston Female Urology as we seek to provide expert medical advice, life-changing procedures and uncompromised personal care to every woman who walks through my door.

From the bottom of my heart – thank you.

Dr. P

It’s World Continence Week! Reach out for help

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Yes, there is a day or a week for just about everyone and every cause these days! But this one is near and dear to my heart, because I see women every day whose lives are affected negatively by incontinence. Fortunately, I also get to see how their lives are greatly improved by our treatments. World Continence Week is an annual initiative with a primary goal of raising awareness about issues related to bladder control. You probably know that incontinence is the involuntary leakage of urine, but did you realize that bladder control problems are preventable, and they can be managed and often cured?

This is a hard topic for many people to talk about, and believe me, I completely understand. Of all the medical issues that women talk about with their friends, for some reason, they do not want to talk about this issue. Some of my patients even hide it from their husbands. Incontinence is a sensitive subject, and it affects an estimated 400 million people around the world.

Because this sometimes feels too taboo to discuss, World Continence Week has stepped in to draw attention to the problems and increase awareness about the condition. At the end of the day, this week is about giving a voice to those who suffer while boosting their confidence to seek help from a doctor and improve quality of life.

I want you to know that if you are suffering with incontinence issues, or you know someone who suffers, you can start the process today to begin changing your life for the better. Here are three easy steps that you can begin right now. I have found these to actually be curative in some cases.

  • Reduce your intake of caffeine. Think coffee, tea and sodas.
  • Make diet modifications. Spicy and acidic foods can trigger an overactive bladder.
  • Establish a bathroom schedule. Urinate before you have the urge.

There are many other options to consider in your journey to treat and cure incontinence. I have created a bladder treatment pathway to make it easy to see the various treatment options and guide you most quickly to the therapy that will work for you. We can discuss the best route for you during a visit to my office. My staff and I talk about this every day, so leave your embarrassment at the door! We are here to care for you and walk beside you as we tackle this issue.

We can discuss:

  • Pelvic Floor exercises, either at home or through our pelvic muscle toning program
  • Bladder neurostimulators that retrain the bladder nerves and is often a permanent solution
  • Bladder Botox, administered easily in the office to relax the bladder muscle
  • Medications
  • Surgery, such as a simple outpatient 15 minute procedure with 95% success rates

Take action this week! I promise it’s worth it. It can literally change your life.

Dr. P

Bladder Botox: bringing relief to my patients

Botox is well known for its cosmetic purposes. If we’re honest, the first thing that comes to mind for most people is a procedure that targets and relaxes facial wrinkles. Fortunately for those suffering with urinary incontinence, Botox can also provide a powerful answer for this problem. This can be treated with an injection in the muscle of the bladder to ease the symptoms of an overactive bladder.

The New York Times recently conducted an in-depth report on incontinence. The study found that, “About 20 million American women … have urinary incontinence or have experienced it at some time in their lives. The number, however, may actually be higher because most patients are reluctant to discuss incontinence with their doctors. In fact, research indicates that many patients will not admit to having the problem even when questioned directly.”

As a urologist who exclusively treats females, the last thing I want is for my patients to feel like they have to stay quiet and learn to live with this condition. I’m always pleased to tell women about bladder Botox and the relief and freedom it provides. I understand that this is a tough topic to approach for many, but my team at Houston Female Urology handles this discussion with empathy, care and kindness.

Bladder Botox is a quick in-office procedure that is well tolerated by our patients. The treatment begins by flushing the bladder with a local anesthesia through a catheter to numb the bladder. Then a scope is passed up the urethra into the bladder, and a small needle is placed through the scope where several injections are made to spread the Botox throughout the muscle of the bladder. This significantly relaxes the bladder, and my patients are able to return home on the same day of the procedure.

The Botox begins to work at about one week with its full effects beginning at two weeks. While this procedure is not permanent, it lasts approximately six to eight months when injected in the bladder. There are no limitations to the extent of use, and my patients are so happy with the results I tend to see them once or twice each year for Botox injections.

One of the best parts of my job is bringing hope to women who often silently struggle with urology issues. It’s so rewarding to see my patients’ faces when they see the light at the end of the tunnel after Botox – they have their lives back.

Dr. P

Thanking God for the privilege

It has been a long time since I wrote in my blog.  The holiday season is very busy for surgeons (having met their deductible, many people try to have surgery before the end of the year), and then the time just got away from me.   I started this entry right before Thanksgiving.

As a Christian, my life is dedicated to trying to bring glory to God in any little way that I can.  Now, I often fail, but it’s a striving and a focus that informs my day to day living.  I don’t think that we have a “spiritual life” and a separate “secular life”.   I think it is all integrated.   As such, when I come into an exam room or the operating room, I am thinking “What is God doing here?  How can I join in with His work?”  Sometimes it is as simple as giving her an antibiotic, other times it is praying about a struggle in her life, or praying that the surgery and recovery go well, and using my surgical skills to help her.

I used to pray with every patient before surgery and take a spiritual history on every patient, but that began to seem a little too rote and forced.  Now I follow the leading of the Spirit.  When I feel that I need to pray or ask probing questions, I do it.  It is amazing how God answers, often in ways I didn’t expect.   Just the other day, I prayed with a patient who had just found out she had rectal cancer.  I could see that she needed the comfort of knowing that God will be with her in her fight.

Patients are often surprised to have their doctor pray with and for them. Sometimes I feel a little silly praying for a what is for me a simple routine bladder lift; I mean, it’s not brain surgery or heart surgery. But then again, for the patient, there is nothing simple or routine about it.  I typically pray for the surgery to go well, for the entire OR team, for the patient to be healed and to recover well, and for her to have peace as she goes into surgery.   Most patients are very grateful for the prayer.  Occasionally I can see that someone feels uncomfortable, so I try to be sensitive to that before I pray.

I have some examples that show how God has answered prayers in my practice and in my life.  One day the robot at the hospital broke down before my case.  That was just one of many things that had happened that day.   There were odd delays and unexpected events that occurred. Everyone did great and no one was harmed by any of the issues.   But it was really stressful on me, because things weren’t going smoothly.   I just continued to lean on the Lord and pray for my patients and for our whole surgical team.   One of my patients told me that she was shocked when I prayed for her, but she told me that a sense of peace filled her heart and any nervousness that she had was gone.  Her surgical procedure was changed at the last minute due to the equipment malfunction so there was a lot of anxiety for her.  But the Lord gave her amazing peace.  She is now several weeks postop and doing great.

Another example was a stone case. I had been covering this patient in prayer for a few days prior to the surgery date due to her underlying health issues and the size of her stone.  This case went from a simple laser case to an open bladder case because the stone was bigger and harder than anticipated.    I was also concerned because I thought the bladder had partially ruptured when I was using the laser.  When I realized that I had to open her up, I called my office to let them know that I would be running late for my other patients due to the change in the plan.  I didn’t know it at the time, but my staff then all took a moment to join hands and pray for our patient.   Well, the open surgery went about 500% better than I had expected:  there was no rupture, the bladder was not as malformed as I thought it might be given her underlying disease, and the stone popped right out (it was about a 4 inch stone).  Another answered prayer!  She recovered beautifully and is doing better than ever.

Not only do I pray for my patients, but my staff does, too.   We all get to participate in what God is doing.  He cares about every part of our lives, even our urological health!

I have always been so thankful for the privilege of being a doctor and specifically a female urologist.  I hope that God is honored in my service to my patients.   I am humbled for the opportunity.